Evaluation of uncomplicated acute respiratory tract infection management in veterans: A national utilization review
| Autor: | Bohan, Jefferson G, Madaras-Kelly, Karl, Pontefract, Benjamin, Jones, Makoto, Neuhauser, Melinda M, Bidwell Goetz, Matthew, Burk, Muriel, Cunningham, Francesca, ARI Management Improvement Group |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Epidemiology Inappropriate Prescribing Practice Patterns Medical and Health Sciences 7.3 Management and decision making Clinical Research Humans Respiratory Tract Infections Lung Aged Veterans Physicians' ARI Management Improvement Group Middle Aged Health Services Quality Improvement Hospitals United States Anti-Bacterial Agents Infectious Diseases Emerging Infectious Diseases Utilization Review Practice Guidelines as Topic Female Guideline Adherence Patient Safety Management of diseases and conditions Infection |
| Zdroj: | Infection control and hospital epidemiology, vol 40, iss 4 |
| Popis: | BackgroundAntibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, and outcomes.MethodsA multicenter quality improvement evaluation was conducted in 28 Veterans Affairs facilities. We included visits for pharyngitis, rhinosinusitis, bronchitis, and upper respiratory tract infections (URI-NOS) that occurred during the 2015-2016 winter season. A manual record review identified complicated cases, which were excluded. Data were extracted for visits meeting criteria, followed by analysis of practice patterns, guideline congruence, and outcomes.ResultsOf 5,740 visits, 4,305 met our inclusion criteria: pharyngitis (n=558), rhinosinusitis (n=715), bronchitis (n=1,155), URI-NOS (n=1,475), or mixed diagnoses (>1 ARI diagnosis) (n=402). Antibiotics were prescribed in 68% of visits: pharyngitis (69%), rhinosinusitis (89%), bronchitis (86%), URI-NOS (37%), and mixed diagnosis (86%). Streptococcal diagnostic testing was performed in 33% of pharyngitis visits; group A Streptococcus was identified in 3% of visits. Streptococcal tests were ordered less frequently for patients who received antibiotics (28%) than those who did not receive antibiotics 44%; P < .01). Although 68% of visits for rhinosinusitis had documentation of symptoms, only 32% met diagnostic criteria for antibiotics. Overall, 39% of patients with uncomplicated ARIs received appropriate antibiotic management. The proportion of 30-day return visits for ARI care was similar for appropriate (11%) or inappropriate (10%) antibiotic management (P=.22).ConclusionsAntibiotics were prescribed in most uncomplicated ARI visits, indicating substantial overuse. Practice was frequently discordant with guideline diagnostic and treatment recommendations. |
| Databáze: | OpenAIRE |
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